HIV and the TPP

By Belinda O’Donnell

The Trans-Pacific Partnership (TPP) may seem peripheral to the ongoing fight against HIV at first glance. Yet many activists and analysts are saying the free trade agreement between the United States and eleven other Pacific Rim countries (New Zealand, Australia, Canada, Mexico, Peru, Chile, Japan, Malaysia, Singapore, Brunei and Vietnam) is worth a second look. If the agreement is successfully adopted, the TPP will shape the new rules of commercial engagement for over 800 million people, spanning 36% of the global economy. The scale and scope of the pending TPP make this a significant agreement on which crucial gains in global health will either be made or reversed.

Specifically, the negotiations have been ferocious over the intellectual property clauses in the final text of the agreement that apply to drugs, vaccines, and diagnostic tools. During an all night session in Atlanta in October 2015, the debate reached a flashpoint, and one trade representative collapsed and required medical attention himself.

After trade ministers from the twelve countries included in the TPP gathered to sign the agreement in Auckland, New Zealand on February 3rd, Médecins Sans Frontières (MSF) put out a statement urging the global health community to speak out against the trade pact, which they see as having “damaging repercussions for access to treatment and innovation worldwide.” In particular, they see the TPP as threatening gains made in securing access to high quality treatment options for people living with HIV.

In a letter to President Obama, MSF USA’s Executive Director Sophie Delaunay and Dr. Manica Balasegaram, Executive Director of the MSF access campaign, expressed concerns that the current text of the agreement will “perpetuate monopolies and prevent generic competition, making medicines and vaccines more expensive for longer.” They urged the President to recognize that important US-funded programs, [like] the United States President’s Emergency Plan for AIDS Relief (PEPFAR) rely overwhelmingly on access to generic options, as 98% of the antiretroviral drugs available through PEPFAR are off-label. MSF fears that the TPP could put this model at risk, especially as new innovations come online for the treatment of HIV and other diseases of global concern.

From the perspective of the USTR, the TPP is not a threat to global health initiatives that rely on generics, but rather a blueprint for international norms that promote innovation in global health and elsewhere.

However, amfAR’s Senior Research Advisor, Brian Honermann, labels the USTR’s outlook on HIV and the TPP as “inaccurate.” He notes that the TPP contains “unprecedented intellectual property protections” around data exclusivity and the scope of patentability, both of which could make it harder to integrate new treatment options into large public sector programs that rely overwhelmingly on off-label drugs. For example, Honermann said, “Long-acting antiretrovirals could be a complete game changer in terms of how we treat HIV in the future,” and the TPP could make it harder to secure affordable variations of these. As a result, the TPP really could “change the nature of the generic market.” Reflecting on his work in South Africa, Honermann said, “Had these sorts of provisions been in place, we wouldn’t have had the explosion of medications that made the scale up of antiretroviral therapy in Africa possible.”

The fight to make antiretroviral therapy accessible was not an easy one, and as a result, international norms around intellectual property, trade, and global health should be consistently moving towards greater flexibility. That does not appear to be the case with the TPP.

The anxieties aggravated by the signing of the Trans-Pacific Partnership agreement capture a central debate in global health: What’s the right balance between incentivizing innovation in the production of life saving drugs, and the very urgent requirement that these drugs are made accessible to those that depend on them for their wellbeing or survival? When considering the TPP from a global health perspective, it is essential to ask if the agreement has managed to strike that balance.